OBJECTIVES: To determine the impact on healthcare costs of implementing an enhanced short-stay model of care (ESS-MOC) for arthroplasty at a national level.

METHODS: A budget impact analysis was conducted for Australian publicly and privately funded hospitals providing hip and knee arthroplasty over the years 2023-2030. Population-based sample projections obtained from clinical registry and administrative datasets of all individuals receiving minor-complexity elective hip or knee arthroplasty for osteoarthritis were applied. The ESS-MOC assigned a conservative 30% of eligible patients to an enhanced recovery from surgery (ERAS) pathway comprising shortened acute ward stay (average 2 days versus 4 days with current care) and outpatient rehabilitation. The remaining 70% received a current practice clinical pathway. The primary outcome was total healthcare cost savings post-implementation of the ESS-MOC, with return on investment (ROI) ratio and hospital bed days utilised also estimated. Costs are presented in Australian dollars (AUD), at 2023 prices.

RESULTS: Estimated cost savings for 2023-2030 from implementing the ESS-MOC pathway were AUD641million (95% CI: AUD99million to AUD1250million). This corresponds to a ROI ratio of AUD9.88 (AUD2.3 to AUD18.9). Savings would be 8-fold higher in the private sector (AUD571million vs. AUD70million), primarily attributable to the >80,000 rehabilitation bed days saved annually in this sector. For the period 2023-2030, an estimated 337,000 (261,000 to 412,000) acute bed days could be saved (private sector 262,000 [200,000 to 324,000]; public sector 74,000 [57,000 to 92,000]). Total implementation costs for the ESS-MOC were estimated at AUD38million and AUD34million for the private and public sectors, respectively. Only a small proportion of eligible patients (2% and 10% in private and public, respectively) would need to move into the ERAS pathway to realize cost savings.

CONCLUSIONS: Implementation of an ESS-MOC for eligible arthroplasty patients in Australia would generate significant cost and resource savings, particularly in the private hospital sector.